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Rheumatology 2001; 40: 1416
© 2001 British Society for Rheumatology
Letters to the Editor |
How many patients are eligible for anti-TNF therapy in the UK?
Rheumatology Department, Birmingham Heartlands & Solihull Hospitals NHS Trust, Bordesley Green East, Birmingham B9 5SS, UK.
SIR, Anti-tumour necrosis factor (TNF) therapies (infliximab and etanercept) are the first scientifically designed biological response modifiers to be licensed for use in rheumatoid arthritis (RA). Other novel therapies, such as interleukin 1 receptor antagonists, are in development. A British Society of Rheumatology (BSR) working party has prepared guidelines for the use of these drugs, restricting their use initially to those who have failed a satisfactory trial of conventional anti-rheumatoid arthritis drugs, have active disease (defined as DAS28 score &!hairsp;>5.1) and are not excluded due to any contraindications such as infection or malignancy.
We were unable to find any data about the predicted use of these medications in the UK once funding became available. Using published prevalence and clinical trial data it is possible, however, to estimate the likely numbers of patients who will be eligible for these therapies once they become widely available. Based on a population of 1200000 in Birmingham, these data suggested that 162 patients would currently be suitable for treatment, with a further 24 new patients each year becoming eligible for treatment (see Table 1). 
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These figures are based on a number of assumptions rather than on local clinical data. In order to refine this estimate further, we carried out a local study at Birmingham Heartlands Hospital (BHH) and Solihull Hospital (SH) Rheumatology Department.
The sample population studied consisted of all patients with a diagnosis of RA who attended a general rheumatology clinic between 1 February 2000 and 31 September 2000, giving a sample number of 113. As defined by the BSR guidelines, patients eligible for treatment were identified on the basis of their treatment history, disease activity and the potential contraindications for therapy. Information had been collected during the clinics, as part of another project undertaken by the department, and any missing data were collected retrospectively from the clinical records. Out of the 113 patients, a total of seven (6.2%) fulfilled BSR guidelines for treatment with anti-TNF therapy. Five of these seven patients would have received the treatment once it became available, according to the clinical judgement of the clinician responsible for their care, while in the other two cases alternative disease-modifying anti-rheumatic drug therapies could be used.
We identified, by clinic letter review of the last full year's data available (1999), a total of 636 RA patients attending BHH and estimated a total RA population of 877 patients attending BHH and SH based on the relative levels of clinical activity across both sites. Because seven of our sample of 113 patients were eligible for treatment, we can estimate that 54 of the total number of patients under the care of the department will receive treatment. The catchment population for BHH and SH is 450000, giving an estimated figure for the Birmingham population of 12 per 100000 (equating to a total of 144) being eligible for therapy and 8.6 per 100000 requiring it (equating to a total of 103).
These figures are lower than the estimates derived from published prevalence data, but still indicate a considerable resource requirement in order to provide appropriate care to our patients. This information should be helpful to those planning the provision of care to RA patients in the UK.
Notes
Correspondence to: K. Douglas. 
Accepted 20 April 2001
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